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Electronically Filed
Supreme Court
SCWC-XX-XXXXXXX
30-DEC-2025
12:03 PM
Dkt. 52 OP
IN THE SUPREME COURT OF THE STATE OF HAWAIʻI
---o0o---ROXANNE K. LANE,
Petitioner/Claimant-Appellant-Appellant,
vs.
AVIS BUDGET GROUP, INC.,
Respondent/Employer-Appellee-Appellee,
and
GALLAGHER BASSETT SERVICES, INC.,
Respondent/Insurance Adjuster-Appellee-Appellee.
SCWC-XX-XXXXXXX
CERTIORARI TO THE INTERMEDIATE COURT OF APPEALS
(CAAP-XX-XXXXXXX; CASE NO. AB 2017-006; DCD NO. 2-14-48809)
DECEMBER 30, 2025
McKENNA, ACTING, C.J., EDDINS, GINOZA, AND DEVENS, JJ.,
AND CIRCUIT JUDGE NICHOLS, ASSIGNED BY REASON OF VACANCY
OPINION OF THE COURT BY DEVENS, J.
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I. INTRODUCTION
This appeal arises from a workers’ compensation claim filed
by Roxanne Lane (Lane) with her employer Avis Budget Group Inc.
(Avis or Employer). The dispositive question in this
controversy is whether Lane sustained a nasal fracture as a
result of a vehicle collision that occurred at work. The
Director of the Department of Labor and Industrial Relations
(DLIR Director) determined that Lane’s nasal injury was a
compensable work-related injury. 1 On appeal to the Labor and
Industrial Relations Appeals Board (LIRAB), the LIRAB reversed
the DLIR Director’s determination as to the nasal fracture,
concluding that the injury did not result from the collision.
The Intermediate Court of Appeals (ICA) affirmed the LIRAB.
We hold that the Employer did not meet its initial burden
of production in adducing substantial evidence to rebut the
legal presumption of compensability for Lane’s nasal injury.
Lane was at work operating an Avis van when another vehicle
reversed into the front of the van while Lane was at a full
stop. The evidence indicated that during the collision, Lane’s
body “went forward and backward, and her nose hit the steering
wheel.”
As a consequence of the collision, Lane sustained several
1 The DLIR Director denied compensability for Lane’s claimed left ankle injury.
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injuries and pursued a claim for workers’ compensation benefits.
In the Employer’s WC-1 “Employer’s Report of Industrial Injury”
(WC-1 report), the Employer identified Lane’s neck, low back,
and right shoulder as injuries sustained in the collision. The
Employer accepted liability for those injuries under Hawai‘i
Revised Statutes (HRS) Chapter 386. By accepting compensability
for those injuries, the Employer implicitly conceded that the
subject collision was of sufficient force to have caused Lane
bodily injuries.
The only injury at issue in this appeal is a right-sided
non-displaced nasal fracture, which Lane contends resulted from
the collision, but was omitted from the Employer’s WC-1 report.
The Employer argues there was substantial evidence that Lane’s
nasal fracture was not caused by the collision, including a
doctor’s opinion that the force of the collision was
insufficient to have caused Lane to strike her nose against the
steering wheel, thus rebutting the statutory presumption of
compensability. In opposition, Lane points to the medical
records documenting her complaints and symptoms affecting the
“right side of [her] face,” “[p]ain along right side of nose,”
“sinus pain,” “nasal congestion,” and “facial pressure” that she
reported to her doctors within hours and days after the
collision, and which the LIRAB did not discredit. X-ray imaging
taken seven days after the collision confirmed that Lane had
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sustained a “[n]ondisplaced right-sided nasal bone fracture.”
In support of its decision, the LIRAB relied on a
biomechanics opinion provided by the Employer’s medical doctor,
who opined that the “force involved in the accident” was low and
could not have caused Lane to hit her nose on the steering
wheel. However, there was no evidence in the record that this
doctor was qualified to offer such an opinion in that field of
expertise.
We hold that the LIRAB’s decision was, in part, clearly
erroneous, and vacate the ICA’s September 27, 2024 Judgment on
Appeal, vacate in part the LIRAB’s November 26, 2019 Order and
January 22, 2020 Order Denying Reconsideration as they relate to
the finding that Lane did not sustain a compensable work-related
injury to her nose, affirm the DLIR Director’s December 30, 2016
decision finding Lane’s nasal injury was compensable, and remand
the case to the LIRAB for further proceedings consistent with
this opinion.
II. BACKGROUND
A. Lane’s Injuries
Lane was employed with Avis as a transporter who delivered
cars between the airport and hotels on Oʻahu. On October 26,
2014, Lane was operating an Avis van when she was involved in a
motor vehicle collision in the airport parking lot. Lane was at
a complete stop when a customer from another car rental agency
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reversed their vehicle into the front of her van. Lane
testified that at the time of the impact, she was restrained by
a seat belt and was “popping [her] horn.” She further testified
that when the car hit the van’s front bumper, her nose hit the
steering wheel “hard.” Lane described the situation as a
“commotion,” as the other driver blamed her for causing the
collision.
Later that same day, Lane was seen at the emergency room at
Pali Momi Medical Center, which charted Lane’s injuries and
complaints, including “discomfort to the right side of [her]
face” and “pain to [her] right neck[.]” (Emphasis added.)
Tenderness to her cervical back and right trapezius muscle was
also entered in the emergency room records. The records noted
that Lane “[d]enie[d] head injury.” X-rays were taken of Lane’s
spine but not her nose.
The following day, on October 27, 2014, Lane was examined
by Dr. Darwin Chan at Concentra Medical Centers. Lane’s ear,
nose, and throat were “[r]eviewed and found to be negative.”
However, Dr. Chan reported that Lane was experiencing “facial
pressure,” lightheadedness, headache, and dizziness, along with
neck and back pain. Dr. Chan also indicated no “erythema or
edema of the external ears or nose.”
Two days after the collision, on October 28, 2014, Lane was
seen by Dr. Rae Teramoto who noted in the medical records that
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Lane was complaining of “[s]inus congestion and headache since
yesterday[.]” Significantly, Dr. Teramoto reported that Lane
was experiencing “[p]ain along right side of [her] nose.”
(Emphasis added.)
The same day, Lane also saw Dr. Ronald Kienitz at Concentra
Medical Centers. Lane complained of sinus pain and congestion,
joint pain, muscle pain, right shoulder pain, back pain, neck
pain, joint stiffness, night pain, and headache. Notably,
Dr. Kienitz wrote in his records that Lane “[f]eels that the
impact in [the motor vehicle accident] caused [sinus pain and
congestion] to flare up.” Dr. Kienitz prescribed nasal sprays,
and with respect to Lane’s ear, nose, and throat exam, he
reported “nasal congestion, sinus pain w/ percussion, sl large
SM nodes[.]”
Lane was referred to physical therapy. The October 29,
2014 therapy records documented continuing complaints of sinus
pain and congestion along with neck pain.
That same day, Lane was seen by Dr. Jack Hsieh.
Dr. Hsieh’s records noted a frontal headache as well as neck
pain, right shoulder pain, and low back pain. The doctor’s exam
and assessment indicated that Lane was experiencing a cervical
strain, right shoulder strain, lumbar spine strain, myofascial
pain, and headaches with pain levels reaching 10/10 in
intensity, with ten indicating the worst pain. Dr. Hsieh’s
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“external inspection” of Lane’s nose and ears was reported as
“normal.” 2
Lane’s therapy records from October 30, 2014 documented
ongoing complaints of neck and mid-to-low back pain.
On November 2, 2014, seven days after the work accident,
Lane went to the emergency room at Kapiʻolani Medical Center for
Women and Children (Kapi‘olani Medical Center). Lane initially
went to the emergency room because her daughter was sick. While
at the hospital, Lane “registered to see why [she] was getting
these headaches non stop and couldn’t focus, couldn’t
concentrate on anything.” She was seen by Dr. Jaimie Tom, who
recorded in the clinical notes that Lane’s primary complaint was
“persistent nasal pain that has been ongoing now for the past
week.” Dr. Tom ordered x-ray imaging of Lane’s nose which
“show[ed] a nasal bone fracture.” Consistent with Lane’s
earlier complaints of pain along the right side of her nose,
documented by Dr. Teramoto two days after the collision, the
x-rays revealed a “[n]ondisplaced right-sided nasal bone
fracture.” (Emphasis added.) Dr. Tom diagnosed Lane with a
nasal fracture, but also noted that there was no significant
swelling, obvious deformity, septal hematoma, or septal
deviation, with only “faint ecchymosis over the nasal bridge.”
2 Dr. Hsieh’s examination of Lane’s ears, nose and throat noted “no hearing loss and no sore throat,” but mentioned nothing about her nose other than the “external” inspection was normal.
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Dr. Tom’s records further reflected that Lane experienced facial
pain after the collision and had “quite a bit of epistaxis, but
that has resolved.” 3
On November 7, 2014, Lane was seen by Dr. Hsieh whose
diagnosis included cervical spine strain, right shoulder strain,
lumbar spine strain, lumbar radiculitis, headache, nasal
fracture, and myofascial pain.
On November 24, 2014, Lane returned to Kapiʻolani Medical
Center where she saw Dr. Anthony Dumpit, who diagnosed Lane with
blurred vision, chest pain, nausea, dizziness, and headaches,
and documented that Lane was experiencing tenderness in the
sinuses but no nosebleeds.
The Employer’s WC-1 report noted that Lane had sustained
cervical, lumbar, and right shoulder injuries related to the
subject motor vehicle collision. The Employer accepted
compensability for those injuries. Lane later filed a WC-5
“Employee’s Claim for Workers’ Compensation Benefits” (WC-5
claim) seeking coverage for the additional injuries to her
“head, brain, face, blurred vision, nose (fracture), neck, right
shoulder, back, ribs [and] left ankle, [c]oncussion, [h]eadaches
and dizziness,” and dysphagia along with psychological injuries
including depression, anxiety, and mental distress, which the
3 “Epistaxis” refers to nasal bleeding.
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Employer denied. (Emphasis added.)
B. Employer’s Medical Examiner Reports
Pursuant to HRS § 386-79 (2015) (Medical examination by
employer’s physician), Lane was examined by two medical doctors
designated by the Employer.
1. Dr. Leonard Cupo
The first doctor, Dr. Leonard Cupo, examined Lane on
January 13, 2015, over two months after the collision. Lane’s
chief complaint at the time of the exam was nasal pain and pain
to her cervical spine, right shoulder, and lumbosacral spine.
a. No Acute Symptoms
Dr. Cupo concluded that Lane’s nasal fracture was not
caused by the collision. Dr. Cupo opined that Lane’s nasal
fracture “bears no relationship to and was not caused,
aggravated, or accelerated by the motor vehicle accident[.]”
Dr. Cupo based his opinion on Lane’s medical visits from
October 26, 2014 to November 2, 2014, explaining that Lane did
not complain of nasal pain or demonstrate an “abnormality”
during the physical examination on October 26, 2014 such as
“edema, ecchymosis, or tenderness.” That is to say, Dr. Cupo’s
opinion rested in part on the purported absence of acute
physical symptoms. Dr. Cupo explained that if Lane sustained a
nasal fracture during the collision, she “would have been
acutely and markedly symptomatic” when she was evaluated at the
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emergency room on October 26, 2014.
Dr. Cupo wrote that Lane’s first clinical notes relating to
nasal pain were reported to Dr. Teramoto on October 28, 2014,
but that Dr. Teramoto’s report did not document that the nasal
pain was related to the collision. Further, Dr. Cupo stated
that the medical records from the day of the collision did not
indicate any nasal bleeding despite Lane later reporting that
she experienced nasal pain associated with epistaxis at the time
of the collision. Dr. Cupo did not opine as to an alternative
cause of Lane’s nasal fracture.
b. Opinion on Biomechanics
Of particular significance, Dr. Cupo opined that the
“intensity of force” from the impact was “low and thus could not
have caused [Lane] to strike her nasal bridge on the steering
wheel,” especially if she was restrained by her seatbelt and
beeping the horn with her right hand.
After viewing the video of the collision, Dr. Cupo
supplemented his initial report stating that there was “no
indication that the employee was in pain on the surveillance
videotape of 10/26/14” and that the “intensity of the force”
noted in his earlier report was confirmed by his review of the
video.
Dr. Cupo did not quantify or otherwise explain the level of
force required for Lane to strike the steering wheel and sustain
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a nasal fracture, nor did he cite to any biomechanical, accident
reconstruction, or engineering findings or calculations made in
support of his opinion that the force generated by the impact
was insufficient for Lane to have sustained a nasal injury.
Dr. Cupo’s report also did not reflect that he had any relevant
qualifications, training, or expertise in these fields.
2. Dr. Vern Sasaki
Over two-and-a-half years after the collision, the Employer
had Lane examined by a second medical doctor, Dr. Vern Sasaki,
on July 6, 2017. Dr. Sasaki concluded that Lane’s nasal
fracture did not result from the impact. Dr. Sasaki opined that
Lane’s nasal fracture was first apparent on November 2, 2014,
and that the prior medical examinations on October 26, 2014,
October 27, 2014, and October 29, 2014 “did not reveal any
findings of a nasal fracture or complaints of nose pain or
swelling,” including Dr. Hsieh’s examination on October 29,
2014, which “revealed a normal nose examination.” Dr. Sasaki
advanced that Lane’s nasal fracture occurred “sometime after
10/29/14 and before 11/02/14 when her nasal fracture was
diagnosed in the Emergency Room,” but provided no opinion as to
an alternative cause of Lane’s nose injury. Dr. Sasaki
acknowledged that Lane reported facial pain on the right side of
her face along with neck and back pain at the emergency room on
the day of the collision, as well as sinus pain and headaches
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during her follow-up visits at Concentra Medical Centers.
Dr. Sasaki stated that with a nasal fracture, he would expect
acute clinical symptoms to appear “almost immediately,” and that
the “amount of force” required to cause a nasal fracture would
have to be “significant.”
Dr. Sasaki also cited Dr. Cupo’s review of the video
footage of the collision, noting that Dr. Cupo’s observations
“validated that the collision was a low-speed collision[.]”
Dr. Sasaki did not indicate that he personally reviewed the
video.
C. Injuries Accepted by Employer
The Employer accepted Lane’s neck, back, and right shoulder
injuries as compensable workers’ compensation injuries but
denied liability for Lane’s nasal injury.
D. DLIR Director’s Decision
The DLIR Director reviewed the Employer’s denial of Lane’s
nasal injury and the additional injuries claimed in Lane’s WC-5
claim. HRS § 386-73 (2015).
In a decision issued on December 30, 2016, the DLIR
Director credited various medical reports, including the reports
from the Pali Momi emergency room, Dr. Teramoto, Dr. Kienitz,
and Dr. Hsieh, and noted that the Employer did not present an
alternate explanation for Lane’s nasal injury. The DLIR
Director reviewed the surveillance video of the collision from
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two angles and observed an “obstruction from both angles in the
form of tinted windows of the claimant’s vehicle and a large
umbrella.”
The DLIR Director determined that Lane’s nasal injury and
the injuries to her neck, back, right shoulder, head, ribs, and
vision were compensable work-related injuries caused by the
collision, but did not find that Lane’s left ankle injury was a
compensable consequence of the collision. 4
E. LIRAB’s Decision
Lane appealed the DLIR Director’s decision on her left
ankle to the LIRAB. HRS §§ 386-73, -87 (2015). As is relevant
to this appeal, one of the issues raised before the LIRAB was
whether Lane’s nasal injury was caused by the subject collision.
At the LIRAB trial, Lane testified and described how the
collision occurred: “So I reversed back, stopped completely.
They’re reversing back. Popped my horn. He just completely hit
me by the right side of the bumper.” In describing the impact,
she testified, “It was like a [sic] impact. It was like
[everything] just hit,” with the impact causing a “dent in the
rear of [their] car.” Lane further testified that she hit her
nose “hard” on the steering wheel, and explained that when it
4 On December 1, 2015, Lane suffered a left ankle injury while exiting a bus after a doctor’s appointment. Lane was diagnosed with a left ankle “sprain.” Lane sought workers’ compensation for the ankle injury as the result and consequence of her compensable work-connected injuries related to the vehicle collision.
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happened, it was “like a flash at the moment the car hit[.]”
Lane also testified that she was “complaining the next day every
day” about her nose to her doctors, who told her it was a sinus
infection and only gave her nose spray and prescription
medication that “wasn’t working.” As a result of hitting the
steering wheel, Lane testified that she “[f]elt pain to [her]
whole face,” but did not tell the doctor at the emergency room
that she hit her head on the steering wheel “because I just felt
funny like I wanted to pass out after . . . the whole commotion.
After I had to take the car back . . . just felt like fainting.”
The Employer did not call Dr. Cupo or Dr. Sasaki, or any
other witness to testify at the trial.
Following the trial, the LIRAB issued its decision
affirming in part and reversing in part the DLIR Director’s
decision. Relevant to this appeal, the LIRAB affirmed the
compensability of Lane’s injuries to her head, ribs, and vision
after determining that the Employer had not met its burden of
producing substantial evidence to rebut the presumption of
compensability. However, the LIRAB reversed the DLIR Director’s
decision as to Lane’s nasal fracture, determining that it was
not a work-related injury. As to Lane’s nasal injury, the LIRAB
concluded that the Employer: (1) “met its burden of producing
substantial evidence to rebut the presumption for
compensability”; and (2) “met its burden of persuasion to rebut
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the presumption of compensability.” The LIRAB’s determination
was based primarily on the reports from Dr. Cupo and Dr. Sasaki.
The LIRAB issued the following pertinent findings of fact
(FOFs):
7. With regard to Claimant’s nose, Dr. Cupo opined that
Claimant’s nose fracture was not caused, aggravated, or
accelerated by the October 26, 2014 accident. He explained
that Claimant did not complain of nasal pain or abnormality
when seen at the emergency room and that the force involved
in the accident could not have caused her to strike her
nasal bridge on the steering wheel, specially [sic] if she
had her right hand on the steering wheel to beep her horn.
8. To Dr. Sasaki, Claimant reported that her head and
face hit the steering wheel in the October 26, 2014
accident, but she did not have a bloody nose. Dr. Sasaki
opined that Claimant’s nasal fracture occurred between
October 29, 2014 and before November 2, 2014.
9. The foregoing is substantial evidence that, if true,
would be sufficient to rebut the presumption of
compensability with regard to Claimant’s nose.
10. Employer met its burden of production to initially
present substantial evidence that if true, could rebut the
presumption that Claimant’s nose fracture was not related
to the October 26, 2014 accident.
11. The October 26, 2014 collision was not “extreme,” as
stated by PA Acree.
12. Dr. Cupo’s description that the collision did not
even move the van, is more accurate, in that the video
showed that it only caused a slight quiver.
13. Upon exiting the vehicle a short time after the
collision, Claimant did not attend to her face or nose.
14. Claimant did not complain of any issues with regard
to her nose when she visited the emergency room on
October 26, 2014.
15. The Board credits Dr. Chan’s October 27, 2014
examination of Claimant’s nose to have no erythema or edema
present.
16. The Board credits Dr. Hsieh’s October 29, 2014
examination of Claimant’s nose to be normal.
17. The Board does not credit Claimant’s November 2, 2014
representation to emergency personnel that she had “quite a
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bit of epistaxis.”
18. The Board credits her representation to Dr. Sasaki
that she did not have a bloody nose.
19. The Board also credits Dr. Cupo’s opinion that the
force of the collision was low and could not have caused
Claimant to strike her nasal bridge on the steering wheel,
particularly because she was beeping her horn.
20. Weighing the evidence elicited by Employer against
the evidence elicited by Claimant, Employer met its burden
of persuasion to rebut the presumption of compensability.
(Emphases added.)
The LIRAB also issued conclusions of law (COLs). Relevant
here, COL 4 provided, “Claimant did not sustain a personal
injury to her nose on October 26, 2014, arising out of and in
the course of employment.”
Lane’s motion for reconsideration was denied by the LIRAB.
F. ICA Proceedings
1. Parties’ Arguments to the ICA
Lane appealed to the ICA contending that the Employer did
not present substantial evidence to overcome the presumption of
compensability and, thus, the LIRAB erred in determining that
her nasal injury was not a work-related injury.
Lane challenged the LIRAB’s FOFs 7-12, 14-17, 19 and 20 and
COL 4 relating to her nasal fracture. Lane argued that the
LIRAB erred because there was no substantial, reliable, and
consistent evidence to rebut the presumption of compensability,
including substantial evidence to meet the Employer’s initial
burden of production. Specifically, Lane pointed to the post16
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collision examinations by Dr. Chan and Dr. Hsieh, which did not
establish the absence of a fracture because no x-ray imaging was
administered.
Lane also argued that the LIRAB erred in crediting
Dr. Cupo’s opinion “regarding the force of the collision”
because: (1) the LIRAB ignored Dr. Cupo’s bias; (2) Dr. Cupo’s
conclusion that the van did not move after the collision was
inconsistent with the LIRAB’s finding that the van “quivered”;
and (3) Dr. Cupo was not qualified as a biomechanics expert or
accident reconstruction expert.
Lane further asserted that Dr. Cupo’s and Dr. Sasaki’s
reports contained general medical conclusions and failed to
identify the cause of Lane’s nasal fracture. Additionally, Lane
argued that neither Dr. Cupo nor Dr. Sasaki were qualified to
opine on the video of the collision.
Lane also contended that because the Employer had conceded
that the collision caused injuries to her neck, back, head,
ribs, and vision, the Employer could not at the same time claim
that the collision was too minimal for Lane to have injured her
nose. Lane asserted that any reasonable doubt as to whether an
injury is work-connected should be resolved in her favor, and
that the Employer failed to provide an alternative explanation
as to the cause of her nasal fracture other than the collision.
Lane further argued that the LIRAB erred in denying her
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motion for reconsideration.
The Employer countered that there was substantial evidence
to overcome the presumption of compensability. The Employer
noted that: Lane’s testimony about her experiencing nasal
bleeding was not credited; Dr. Chan and Dr. Hsieh reported that
Lane’s nose was normal; the collision did not move the van and
only caused a “slight quiver”; upon exiting her vehicle Lane did
not “attend to her face or nose,” or complain about her nose
when she went to the emergency room on the day of the collision;
and Dr. Cupo determined that the force during the collision
could not have caused Lane to strike her face on the steering
wheel while beeping the horn and restrained by a seatbelt. The
Employer emphasized that the LIRAB’s credibility determinations
should not be disturbed on appeal.
The Employer also asserted that the LIRAB did not abuse its
discretion in denying Lane’s motion for reconsideration because
no new evidence or arguments were presented.
2. Summary Disposition Order
The ICA affirmed the LIRAB’s decision, concluding that
substantial evidence supported the LIRAB’s findings and that the
Employer met the “high burden” of rebutting the presumption of
compensability for Lane’s nasal injury. The ICA cited
Dr. Cupo’s and Dr. Sasaki’s opinions that Lane would have been
symptomatic had she sustained a nasal fracture in the collision,
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and that she did not report a nasal injury nor were there
clinical symptoms of bruising, swelling, or nose bleeding on the
day of the collision and the few days thereafter. The doctors’
reports, the ICA found, supported the Employer’s position that
the nasal fracture was not caused by the collision.
The ICA concluded:
[T]he LIRAB did not clearly err in crediting the doctors’
opinions, which specifically, directly, and expressly
address the presumption that Lane injured her nose in the
October 26, 2014 workplace accident. Accordingly, we
further conclude that the LIRAB did not err or abuse its
discretion in entering the November 26, 2019 Order.
The ICA also concluded that the LIRAB did not abuse its
discretion in denying Lane’s motion for reconsideration because
Lane did not make any argument in support of this point of
error.
G. Supreme Court Proceedings
1. Application for Writ of Certiorari
We accepted Lane’s application for writ of certiorari. 5
Lane’s primary contention is that the ICA erred in affirming the
LIRAB’s decision because the Employer did not meet its heavy
burden of producing substantial evidence to overcome the
presumption of compensability for her nasal injury, i.e., the
Employer failed to disprove that the injury is work-connected.
Lane notes that the medical records reflected that she
5 Lane timely filed an amended application for writ of certiorari.
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complained of discomfort to the right side of her face during
the initial Pali Momi emergency room visit and complained of
nasal pain and congestion to Dr. Teramoto and Dr. Kienitz, which
neither Dr. Cupo nor Dr. Sasaki addressed.
Lane also contends that the ICA decision is inconsistent
with this court’s prior decisions regarding the evidence
necessary to overcome the presumption of compensability, citing
primarily to our decision in Cadiz v. QSI, Inc., 148 Hawaiʻi 96,
468 P.3d 110 (2020).
2. Employer’s Response
The Employer counters that the LIRAB properly credited
Dr. Cupo’s and Dr. Sasaki’s medical opinions rather than Lane’s
testimony. The Employer asserts that it carried its burden of
rebutting compensability because both Dr. Cupo and Dr. Sasaki
concluded that the collision was low-impact and that if Lane had
sustained her nasal fracture during the collision, she would
have immediately experienced symptoms. The Employer further
contends that Dr. Cupo’s and Dr. Sasaki’s opinions were properly
credited by the LIRAB, the ICA correctly upheld the LIRAB’s
weighing of the evidence, and the LIRAB was not required to
resolve any conflicts in the evidence in Lane’s favor.
III. STANDARDS OF REVIEW
“Appellate review of a LIRAB decision is governed by HRS §
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91-14(g).” 6 Skahan v. Stutts Constr. Co., Inc., 148 Hawaiʻi 460,
466, 478 P.3d 285, 291 (2021) (citations and brackets omitted).
Under those provisions, the reviewing court “may affirm the
decision of the agency or remand the case with instructions
for further proceedings.” The reviewing court also “may
reverse or modify the decision and order if the substantial
rights of the petitioners may have been prejudiced because
the administrative findings, conclusions, decisions, or
orders” (1) violate provisions of the constitution or a
statute, (2) are beyond the agency’s statutory authority or
jurisdiction, (3) used “unlawful procedure,” (4) were
“[a]ffected by other error of law,” (5) were clearly
erroneous, or (6) were arbitrary or capricious “or
characterized by abuse of discretion or clearly unwarranted
exercise of discretion.”
Ihara v. State Dep’t of Land & Nat. Res., 141 Hawaiʻi 36, 41, 404
P.3d 302, 307 (2017) (citing HRS § 91-14(g)(1)-(6)) (cleaned
up).
The LIRAB’s conclusions of law are reviewed de novo, under
the right/wrong standard. Its findings of fact are
6 HRS § 91-14(g) (Supp. 2016) provides:
(g) Upon review of the record, the court may affirm the
decision of the agency or remand the case with
instructions for further proceedings; or it may
reverse or modify the decision and order if the
substantial rights of the petitioners may have been
prejudiced because the administrative findings,
conclusions, decisions, or orders are:
(1) In violation of constitutional or statutory
provisions;
(2) In excess of the statutory authority or
jurisdiction of the agency;
(3) Made upon unlawful procedure;
(4) Affected by other error of law;
(5) Clearly erroneous in view of the reliable,
probative, and substantial evidence on the
whole record; or
(6) Arbitrary, or capricious, or characterized by
abuse of discretion or clearly unwarranted
exercise of discretion.
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reviewable under the clearly erroneous standard to
determine if the agency decision was clearly erroneous in
view of reliable, probative, and substantial evidence on
the whole record. Like any agency findings, the LIRAB’s
findings should be sufficient to allow the reviewing court
to track the steps by which the agency reached its
decision.
Cadiz, 148 Hawaiʻi at 107, 468 P.3d at 121 (cleaned up).
A finding of fact “is clearly erroneous when (1) the record
lacks substantial evidence to support the finding, or (2)
despite substantial evidence in support of the finding, the
appellate court is nonetheless left with a definite and firm
conviction that a mistake has been made.” Est. of Klink ex rel.
Klink v. State, 113 Hawaiʻi 332, 351, 152 P.3d 504, 523 (2007)
(citation omitted).
“In the workers’ compensation context, substantial evidence
means a high quantum of evidence which, at the minimum, must be
relevant and credible evidence of a quality and quantity
sufficient to justify a conclusion by a reasonable person that
an injury or death is not work connected.” Borrson v. Weeks,
155 Hawaiʻi 490, 496, 567 P.3d 195, 201 (2025) (citing Panoke v.
Reef Dev. of Hawaii, Inc., 136 Hawai‘i 448, 462, 363 P.3d 296,
310 (2015)) (quotations and brackets omitted). Substantial
evidence “must be evidence such as a reasonable mind might
accept as adequate to support a claim.” Acoustic, Insulation &
Drywall, Inc. v. Labor & Indus. Relations Appeal Bd., 51 Haw.
312, 314, 459 P.2d 541, 543 (1969).
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IV. DISCUSSION
The crux of Lane’s contention is that the Employer failed
to produce substantial evidence to overcome the statutory
presumption that her nasal fracture was a work-related injury. 7
Even with full regard and due deference to the LIRAB, we hold
that the Employer did not adduce substantial evidence to meet
its initial burden of production to rebut the presumption of
compensability. The evidence relied upon by the LIRAB,
particularly the biomechanics opinion from Dr. Cupo, lacked
foundation to be considered and thus lacked probative value.
“Hawaii’s workers’ compensation statute is to be accorded
beneficent and liberal construction in favor of the employee, to
fulfill the humanitarian purposes for which it was enacted.”
Respicio v. Waialua Sugar Co., 67 Haw. 16, 18, 675 P.2d 770, 772
(1984). HRS Chapter 386 entitles employees injured in the
course of employment to compensation. HRS § 386-3 (2015).
HRS § 386-85 creates a rebuttable presumption that an
employee’s claim is compensable. A claim for compensation is
presumed to be a work-related injury in the absence of
substantial evidence to the contrary. HRS § 386-85 (2015). The
presumption is that the claimed injury is causally related to
7 In her points of error, Lane appears to argue that the ICA applied the incorrect standard of review; however, Lane does not present any argument to support this assertion and, further, the ICA correctly applied the clearly erroneous standard of review to the LIRAB’s FOFs and right/wrong standard to the LIRAB’s COLs. See Skahan, 148 Hawai‘i at 468 n.7, 478 P.3d at 293 n.7.
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the employment activity. Korsak v. Hawaii Permanente Med. Grp.,
94 Hawai‘i 297, 307, 12 P.3d 1238, 1248 (2000); Cadiz, 148
Hawai‘i at 107, 468 P.3d at 121 (citing HRS § 386-85) (“The
workers’ compensation statute rests on the presumption that a
claimed injury is work-connected and therefore compensable.”).
This presumption is one of the “keystone principles” of our
workers’ compensation system. Flor v. Holguin, 94 Hawaiʻi 70,
79, 9 P.3d 382, 391 (2000) (citation omitted). “That
presumption is paramount, in part, because the workers’
compensation statute provides an injured employee’s exclusive
remedy for an injury arising out of and in the course of
employment.” Cadiz, 148 Hawaiʻi at 99, 468 P.3d at 113 (cleaned
up).
The presumption of compensability places a “heavy burden on
the employer to disprove that an injury is work-related.”
Korsak, 94 Hawai‘i at 307, 12 P.3d at 1248. This presumption “is
not a mere procedural device that disappears upon the
introduction of contrary evidence.” Id. (citing Akamine v.
Hawaiian Packing & Crating Co., 53 Haw. 406, 408, 495 P.2d 1164,
1166 (1972)). To rebut the presumption of compensability, the
employer has the burden of going forward with the evidence,
which is the burden of production; and once the burden of
production is met, the employer then has to meet the burden of
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persuasion. Cadiz, 148 Hawai‘i at 99–100, 468 P.3d at 113–14
(citation omitted).
The burden of production requires the employer to initially
introduce substantial evidence that rebuts the presumption that
the injury is work-related. Id. (citation omitted). “After the
trier of the facts first makes the determination as to whether
the evidence adduced by the employer is substantial[,] then
[they are] to weigh and consider the evidence offered by the
employer against the evidence offered by claimants supportive of
the claim.” Acoustic, Insulation & Drywall, Inc., 51 Haw. at
316, 459 P.2d at 544.
“Substantial evidence” signifies a high quantum of
evidence that is, at a minimum, relevant and credible of a
quality and quantity sufficient to justify a conclusion by a
reasonable person that the injury is not work connected.
Korsak, 94 Hawai‘i at 307, 12 P.3d at 1248 (citation omitted).
“In evaluating whether the burden of producing substantial
evidence has been met, ‘the slightest aggravation or
acceleration of an injury by the employment activity mandates
compensation.’” Cadiz, 148 Hawai‘i at 108, 468 P.3d at 122
(quoting Panoke, 136 Hawai‘i at 461, 363 P.3d at 309). If
substantial evidence is not adduced, the “claimant must
prevail.” Chung v. Animal Clinic, Inc., 63 Haw. 642, 650, 636
P.2d 721, 726–27 (1981). If substantial evidence is adduced,
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the LIRAB must then weigh and consider the evidence offered by
the parties with any reasonable doubts as to whether an injury
is work-related resolved in favor of the claimant. Akamine, 53
Haw. at 409, 495 P.2d at 1166.
Here, the Employer did not meet its initial burden of
producing substantial evidence to rebut the presumption of
compensability. Therefore, we need not reach the burden of
persuasion. See id. at 413, 495 P.2d at 1169.
A. Employer did not meet its burden of producing substantial
evidence to rebut the presumption of compensability.
The LIRAB found, and the ICA affirmed, that the Employer
met its initial burden of producing substantial evidence to
rebut the presumption of compensability with respect to Lane’s
nasal injury. The LIRAB’s determination was premised on two
FOFs. The first finding, FOF 7, relied on Dr. Cupo’s opinions
that: (1) the nasal fracture was not caused by the impact; (2)
Lane did not complain of nasal pain or abnormality at the
emergency room; and (3) the “force involved in the accident
could not have caused her to strike her nasal bridge on the
steering wheel, specially [sic] if she had her right hand on the
steering wheel to beep her horn.” The second finding, FOF 8,
was based on Dr. Sasaki’s opinion that Lane did not have a
bloody nose and that “Claimant’s nasal fracture occurred between
October 29, 2014 and before November 2, 2014.”
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Standing on these two FOFs, the LIRAB concluded that these
FOFs constituted “substantial evidence” to rebut the presumption
of compensability with respect to Lane’s nose injury, and that
the “Employer met its burden of production[.]”
The LIRAB then weighed Lane’s medical records generated
from October 26, 2014 through October 29, 2014 together with
Dr. Cupo’s and Dr. Sasaki’s reports, concluding that the
Employer met its burden of persuasion to overcome the
presumption of compensability. Lane cites Cadiz for the
contention that the Employer did not meet its initial burden of
production. We agree with Lane.
1. The record lacks foundation for Dr. Cupo’s opinion
pertaining to biomechanics.
This case rests on whether Lane struck her nose on the
steering wheel. And if Lane struck her nose on the steering
wheel, the pertinent question is whether that could have, in any
way, caused her nose injury. See Korsak, 94 Hawai‘i at 308, 12
P.3d at 1249.
As noted, in FOF 7, the LIRAB relied on Dr. Cupo’s opinion
in concluding that the “force involved in the accident” could
not have caused Lane to strike her nose on the steering wheel.
The LIRAB clearly erred because there is nothing in the
record to indicate Dr. Cupo was qualified to render such an
opinion. Dr. Cupo did not cite to any credentials that
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qualified him as a biomechanics or accident reconstruction
expert. Also, he only offered a “generalized” opinion as to the
force of the impact. See id. at 308, 12 P.3d at 1249 (affirming
that “generalized medical opinions do not constitute substantial
evidence”).
In concluding that the Employer met its burden of
production, the LIRAB relied on Dr. Cupo’s opinion that the
force involved in the collision was “low and could not have
caused [Lane] to strike her nasal bridge on the steering wheel,”
especially if she had her right hand on the steering wheel to
beep the horn. 8 This opinion was offered without any calculation
of the force generated by the collision or the amount of force
transmitted to Lane’s body; any determination as to whether Lane
was sitting completely back in the driver’s seat or leaning
forward at impact placing her body and face in closer proximity
to the steering wheel; or any discussion of whether Lane’s right
arm was bent at the elbow or fully extended as she was beeping
the horn.
This technical and complex subject matter is typically
reserved for experts in biomechanics, accident reconstruction,
8 Dr. Cupo opined that Lane’s right shoulder injury was not caused by the collision, specifically stating, “The right shoulder was not a body part injured at the time of the motor vehicle accident of 10/26/14.” However, not even the Employer deemed Dr. Cupo’s opinion to be credible, as the Employer “accepted liability” for Lane’s right shoulder as a compensable body part injured in the collision.
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engineering, and other disciplines who have the requisite
training and experience in these specialized fields. See Loren
Peck, How Sound Is the Science? Applying Daubert to
Biomechanical Experts’ Injury Causation Opinions, 73 Wash. & Lee
L. Rev. 1063, 1090-1110 (2016). Biomechanics experts analyze
motor vehicle collisions utilizing physics and engineering
principles, along with vehicle manufacturing information, to
assess the forces generated in a collision. The analysis
involves accident reconstruction, which examines factors such as
vehicle weights, impact velocities, impact angles, damage
patterns, vehicle crashworthiness, occupant dynamics, injury
tolerance thresholds, and environmental factors, along with
other relevant data to analyze the forces and energy transfers
involved in a collision. Cf. Udac v. Takata Corp., 121 Hawai‘i
143, 150, n.8, 214 P.3d 1133, 1140, n.8 (Ct. App. 2009) (Expert
Dr. Banks, who had a medical degree and engineering degree, and
taught courses in biomechanics and injury causation analysis,
“testified that he followed five steps in conducting his injury
causation analysis: (1) vehicle motion or vehicle dynamics, (2)
occupant motion or occupant kinematics, (3) biomechanics, (4)
injury potential/injury analysis, and (5) review of medical
records. Dr. Banks testified that ‘[b]iomechanics is the
application of the science of mechanics to biological
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systems.’”).
Thoens v. Safeco Insurance Co. of Oregon involved an expert
opinion on the biomechanics of a motor vehicle collision. 356
P.3d 91 (Or. App. 2015). There, the biomechanics expert opined
as to whether the forces associated with the collision were
sufficient to cause injury to the vehicle occupant. Id. at 101.
The expert testified to his education and training, which
included a bachelor’s degree in engineering, a master’s degree
in biomedical engineering, and a Ph.D. in biomedical
engineering. Id. He also described his significant work and
research background in biomechanics. Id. at 101.
The Court of Appeals of Oregon found the biomechanics
expert’s opinion scientifically valid. Id. at 110. The court
considered, inter alia, the expert’s calculation of the
collision force applied to the driver’s vehicle and “how that
force was transmitted to the driver’s seat, using principles of
physics and taking into account the construction of the car and
its components”; analysis of “how plaintiff's body would have
been affected by that force, given her ‘body habitus, her
height, weight, how she was seated inside the vehicle, [and]
what type of restraint’ was used”; and comparison of the forces
that plaintiff’s body had “experienced in the collision” to a
“‘known level of human tolerance’ based on studies of vehicle
collisions and crash tests as well as his own study of human
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tissues and how they respond to various stresses.” 9 Id. at 102.
Here, there was no showing through testimony, curricula
vitae, or other relevant evidence that Dr. Cupo or Dr. Sasaki,
neither of whom testified at the LIRAB trial, possessed the
requisite expertise or were otherwise qualified to render
forensic biomechanics, vehicular accident reconstruction, or
engineering opinions relating to the collision. See State ex
rel. Jones v. Recht, 655 S.E.2d 126, 132 (W. Va. 2007) (A
medical doctor’s testimony “must be strictly restricted to
medical testimony” and “[i]ssues regarding the force of impact
must be redirected to experts qualified in accident
reconstruction or biomechanics.”). Nor was there any evidence
of scientific methods, studies, or analysis performed in
furtherance of Dr. Cupo’s opinion that it was “impossible” for
Lane to have struck her nose on the steering wheel based on the
9 See also Maines v. Fox, 190 So.3d 1135, 1142 (Fla. Dist. Ct. App. 2016) (holding that a medical doctor with expertise in biomechanical engineering should have been able to testify to forces involved in a motor vehicle collision and whether those forces were enough to cause claimant’s injuries); Johnston-Forbes v. Matsunaga, 333 P.3d 388, 391 (Wash. 2014) (biomechanics expert allowed to testify where the expert reviewed engineering data on both vehicles, bumper crash test information, and performed impact tests on both bumpers); Wilson v. Rivers, 593 S.E.2d 603, 604-06 (S.C. 2004) (finding that a medical expert with a degree in physiology and training in biomechanics who “conducted over 800 impact and injury causation analyses” and had been qualified as an expert in biomechanics in other states, was qualified to testify to forces involved in a motor vehicle collision).
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force involved in the collision. 10
In light of the foregoing, we find that the LIRAB erred in
relying on Dr. Cupo’s opinion on biomechanics, which lacks
foundation and does not justify a conclusion by a reasonable
person that Lane’s nasal injury was not work-related. See
Korsak, 94 Hawai‘i at 308, 12 P.3d at 1249.
Moreover, Dr. Cupo’s report represents the kind of
generalized opinion this court has previously warned against and
summarily rejected in Korsak and Akamine. Korsak, 94 Hawai‘i at
308, 12 P.3d at 1249 (“[P]ursuant to Akamine, generalized
medical opinions do not constitute substantial evidence.”); see
Akamine, 53 Haw. at 410, 495 P.2d at 1167–68. Thus, Dr. Cupo’s
opinions on biomechanics, which Dr. Sasaki relied on for his
opinions, cannot be sustained as substantial evidence. 11
Given the deficiency of the LIRAB’s findings, the critical
10 Although Dr. Cupo opined that it was “impossible” that Lane struck the steering wheel during the impact, the LIRAB found that the collision caused her a head injury. Upon review of the surveillance video, the LIRAB acknowledged that the video had “no clear visual of Claimant’s position or movement within the van[,]” yet that same video purportedly supported Dr. Cupo’s opinion that the collision did not cause Lane’s nasal fracture. And although the LIRAB found that the collision caused a “slight quiver,” it nevertheless credited Dr. Cupo’s opinion that the van did not move.
11 Lane also argues in conclusory fashion that Dr. Cupo is inherently biased because the Employer retained him to examine Lane. In support, Lane filed Dr. Cupo’s 1099 tax form and his testimony from an unrelated workers’ compensation case, in which Dr. Cupo testified that his average fee was “approximately $800 per [independent medical examination (IME)].” Dr. Cupo was retained by the Employer pursuant to HRS § 386-79 which allows an employer to designate a physician of their choice to examine a claimant at the expense of the employer. This is the employer’s statutory right. Neither the LIRAB nor the ICA addresses the argument regarding Dr. Cupo’s
(continued . . .)
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question is whether striking the steering wheel could have, in
any way, fractured Lane’s nose with respect to medical
causation. Korsak, 94 Hawai‘i at 308, 12 P.3d at 1249
(concluding that IME reports failed to directly address whether
claimant’s physical therapy session could have exacerbated
claimant’s condition and were thus insufficient as substantial
evidence). Neither Dr. Cupo nor Dr. Sasaki answered that
question, nor did either doctor point to an alternative cause of
Lane’s injury.
2. Lane’s medical records documented clear and undisputed
evidence of facial and nasal complaints from
October 26, 2014 through October 29, 2014.
In FOFs 7 and 8, the LIRAB credited Dr. Sasaki’s opinion
that the nasal fracture occurred in the compressed window
between October 29, 2014 and November 2, 2014, and Dr. Cupo’s
opinion that Lane did not complain of any nasal related symptoms
at the emergency room. 12 Dr. Sasaki based his medical causation
opinion on the medical records generated between October 26,
2014 and October 29, 2014 in concluding that the records did not
reveal any “complaints of nose pain or swelling.”
Dr. Sasaki’s opinion misstates the undisputed evidence.
The medical records from Drs. Kienitz and Teramoto clearly
bias; however, on this record, we do not find this argument persuasive.
12 Dr. Sasaki stated that the nasal fracture occurred “after” October 29, 2014.
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documented Lane’s nasal symptoms, including persistent nasal
“pain,” before October 29, 2014, which Dr. Sasaki’s report
acknowledged but failed to address. Neither Dr. Sasaki nor
Dr. Cupo specifically explained or accounted for Lane’s rightsided facial complaints in the emergency room 13 or the other
documented complaints Lane was experiencing before October 29,
2014, which included “facial pressure,” persistent “sinus pain
and congestion” since the collision, and “[p]ain along right
side of nose” that Lane attributed to the “impact in [motor
vehicle accident][.]”
The x-ray imaging taken on November 2, 2014 confirmed that
Lane sustained a right-sided non-displaced nasal fracture, the
same side she had been complaining about before October 29,
2014. While the medical records reflect that her neck pain had
improved from the date of the collision leading up to
November 2, 2014, the same records also document that “she
continues to have facial pain.” There was no evidence that Lane
was experiencing any ongoing or frequent nasal or facial
13 The record reflects that the collision occurred at approximately 1:52 p.m. on October 26, 2014, and that Lane was seen in the emergency room at 5:46 p.m., or within four hours of the incident. There is no indication in the emergency room report that Lane’s nose was ever examined on October 26, 2014, with the records showing that Lane seemed more preoccupied with her neck pain, which apparently prompted the doctors to order cervical x-ray imaging. The report references a physical examination of her head, ears, eyes, neck, cardiovascular system, pulmonary/chest, abdominal, musculoskeletal, neurological, and skin. However, the section pertaining to “HENT” (head, ears, nose, and throat) does not provide any information, as that section was left blank. No x-rays were taken of Lane’s face or nose.
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symptoms before the collision. 14 And although it is not required
that an employer provide evidence that definitively establishes
the cause of a claimant’s injury, neither Dr. Cupo nor
Dr. Sasaki explained why Lane would have started suffering
right-sided facial and nasal symptoms following the collision if
the impact had not caused the right-sided nasal fracture.
The Employer argued that the absence of acute external
physical symptoms, or what Dr. Cupo referred to as an
“abnormality,” in the medical records before October 29, 2014
ruled out the possibility that Lane sustained the nasal fracture
from the collision. But Lane did not exhibit such symptoms on
November 2, 2014 when x-rays revealed her nasal fracture. 15
Indeed, the Kapiʻolani Medical Center records from that date
indicated that Lane was not “acutely and markedly symptomatic”
any more than she was during the preceding days when she was
complaining of right-sided facial symptoms and pain along the
right side of her nose. 16 Dr. Cupo himself interpreted those
same records as documenting “no edema or deformity of the nasal
bridge” or “septal deviation or hematoma[,]” yet there is no
14 Both Dr. Cupo and Dr. Sasaki engaged in an extensive review of Lane’s prior medical records and history. Neither report alluded to any entries or doctor visits relating to nasal or sinus complaints predating the collision.
15 On October 29, 2014, Dr. Hsieh reported doing an “external inspection” of Lane’s ears and nose, which he indicated was “normal.”
16 Kapiʻolani Medical Center’s medical records from November 2, 2014--seven days after the collision--confirmed the absence of any “significant swelling,” “obvious deformity,” “septal hematoma,” or “septal deviation.”
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question that Lane’s nose was fractured.
As to Dr. Sasaki’s opinion that Lane did not have a bloody
nose, which the LIRAB relied on in FOF 8, the Employer did not
present any evidence suggesting that a person with a nondisplaced nasal fracture will necessarily experience bleeding.
Significantly, the medical records from Kapiʻolani Medical Center
advised Lane that with a “minor fracture,” “[s]ometimes, there
is also bleeding from the nose” and that it “may” cause
swelling. (Emphasis added.) That is to say, there may or may
not be any bleeding or swelling with a minor non-displaced nasal
fracture and, therefore, the absence of such symptoms is not a
definitive indicator to rule out that a person has suffered a
fracture.
In Panoke v. Reef Development of Hawaii, Inc., this court
held that two medical reports submitted by the employers’
doctors and the expert testimony of a third employer doctor did
not rebut the presumption of compensability because the doctors
did not address how Panoke, a construction worker injured while
maneuvering equipment on a worksite, was “asymptomatic” for a
shoulder injury prior to the workplace incident, “but then
started suffering from shoulder problems shortly afterwards.”
136 Hawaiʻi at 461, 363 P.3d at 309. The claimant in Panoke did
not exhibit “immediate symptoms” following the incident and did
not begin to complain of symptoms until “approximately two weeks
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after the work accident.” Id. at 463-64, 363 P.3d at 311-12.
This court concluded that the absence of symptoms following
a work accident was insufficient to overcome the presumption of
a covered work-related injury. Id. We held that an IME
doctor’s testimony that Panoke’s injury was not aggravated by
the accident because “[h]e would expect immediate symptoms given
the amount of tears” was “not sufficient to constitute
substantial evidence.” Id. at 463, 363 P.3d at 312 (quotations
omitted). We specifically noted, “[T]here is nothing in the
record to explain why Panoke would have started experiencing
serious shoulder pain approximately two weeks after the work
accident if the work accident had not caused the injury or
aggravated some pre-existing injury.” Id. at 464, 363 P.3d at
312. “As a result, the LIRAB erred in concluding that [the
employer] had adduced substantial evidence to overcome the
presumption that Panoke’s shoulder injuries were related to the
. . . work accident as he alleged.” Id.
Similar to the employer’s doctors in Panoke, neither
Dr. Cupo nor Dr. Sasaki explained why Lane was asymptomatic
prior to October 26, 2014 but then started experiencing rightsided nasal and facial symptoms shortly after the collision
occurred and continuing through October 29, 2014. Panoke, 136
Hawaiʻi at 461, 464, 363 P.3d at 309, 312. Here, the LIRAB also
relied on Dr. Cupo’s and Dr. Sasaki’s opinions that Lane would
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have experienced immediate symptoms if the fracture were caused
by the collision. In contrast to the claimant in Panoke, who
began complaining of symptoms two weeks after the workplace
incident, Lane was diagnosed with a nasal fracture within a week
of the incident, after x-ray imaging revealed a fracture.
Contrary to Dr. Sasaki’s conclusions, the record reflects that
Lane did experience immediate and continuing right-sided facial
and nasal symptoms from the date of the collision, October 26,
2014, through October 29, 2014, as well as on November 2, 2014,
the date x-ray imaging revealed the fracture.
Dr. Cupo’s and Dr. Sasaki’s opinions that Lane could not
have sustained the nasal fracture before October 29, 2014 due to
the absence of immediate symptoms do not align with the
uncontroverted evidence, do not address the undisputed findings
charted in Lane’s medical records from October 26, 2014 through
November 2, 2014, and do not provide a sufficient degree of
specificity to constitute substantial evidence to rebut the
presumption that Lane’s nasal injury was work-related.
Accordingly, the Employer did not satisfy its initial burden of
production in rebutting the statutory presumption of
compensability.
B. Employer did not meet its burden of persuasion.
Assuming, arguendo, the Employer had met its burden of
production, the remaining evidence in support of the Employer’s
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burden of persuasion was, at best, conflicting. Any such doubts
would be resolved in Lane’s favor. Borrson, 155 Hawai‘i at 497,
567 P.3d at 202 (citing Akamine, 53 Haw. at 409, 495 P.2d at
1166); Chung, 63 Haw. at 652, 636 P.2d at 727 (Where the
evidence conflicts, “the legislature has decided that the
conflict should be resolved in the claimant’s favor.”). In
Cadiz, we held that “[i]n evaluating whether the burden of
persuasion has been met, the ‘broad humanitarian purpose of the
workers’ compensation statute read as a whole requires that all
reasonable doubts be resolved in favor of the claimant.’” 148
Hawai‘i at 108, 468 P.3d at 122 (citing Ihara, 141 Hawaiʻi at 41,
404 P.3d at 307). Here, since the Employer failed to produce
substantial evidence that expressly, directly, and specifically
rebutted the presumption that Lane’s nasal injury was workrelated, the LIRAB erred in concluding Lane’s nasal injury was
not a compensable injury. See Korsak, 94 Hawai‘i at 308, 12 P.3d
at 1249 (noting the ICA applied the correct analysis of whether
doctors’ reports expressly, directly and specifically rebutted
the presumption that an injury was causally related to the work
accident).
Based on the foregoing, we conclude that the LIRAB’s FOFs
7-10, 12, and 19-20 and COL 4 are clearly erroneous.
Accordingly, they are vacated.
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V. CONCLUSION
For these reasons, we vacate the ICA’s September 27, 2024
Judgment on Appeal; vacate in part the LIRAB’s November 26, 2019
Decision and Order and January 22, 2020 Order Denying
Reconsideration as they relate to the LIRAB’s FOFs and COL that
Lane did not sustain a compensable work-related injury to her
nose; affirm the DLIR Director’s December 30, 2016 decision
finding Lane’s nasal injury was compensable; and remand the case
to the LIRAB for further proceedings consistent with this
opinion.
Michael J.Y. Wong /s/ Sabrina S. McKenna for petitioner
/s/ Todd W. Eddins
Brian G.S. Choy and
Keith M. Yonamine /s/ Lisa M. Ginoza for respondents
/s/ Vladimir P. Devens
/s/ Steven R. Nichols
40